Charmain has worked actively behind the scenes with the Medical Board and Mississippi Department of Health to keep telemedicine companies from operating in Mississippi that would compete with UMMC.

Mississippi Medical Association General Counsel Connor Reeves sent this demand to JJ one hour later:

I’ve seen your comment posted to the “Med Board Cans Executive Director” article at 7:58am today and I’m objecting to its posting. You made an unsubstantiated assertion of fact about actions by Charmain Kanosky and are publishing an allegation that is unfounded and inappropriate. Please remove that comment from the article. Thank you for your attention to this, (Emphasis added by KF)

There is just one problem with my claim: It's true. Mr. Reeves should have checked with his Executive Director before he sent his demand and tried to intimidate this website. The Kingfish obtained a yuuuuge amount of emails last year on telemedicine from the Mississippi State Department of Health.

Telemedicine companies supported a bill last year that would have redefined the practice of telemedicine in Mississippi. They have been fighting the Board of Medical Licensure over what constitutes the practice of telemedicine for quite some time. Earlier post. Some board members (such as Dr. Randy Easterling) and then-Executive Director Vann Craig opposed allowing the use of telephone-only by private telemedicine companies in Mississippi.

As one would expect, the Board, MSMA, and MSDH all watched the 2016 legislative session with worried foreheads and furrowed eyebrows as several telemedicine bills were filed. Gallons of botox were probably needed when the session ended. A Baker Donelson lawyer emailed news about a telemedicine bill (SB #2071) to Vickey Berryman at MSDH on January 27, 2016:

I hope your meeting goes well on your telemedicine bill and sorry I can't make it today.

Here is a bill that has been dropped in the Senate on telemedicine. I haven't broken it down yet so don't know what impact if any it might have on you, but just wanted to spot it for you since you are working on your own regulation.

She forwarded the email to a fellow employee and the attorney for the Mississippi Board of Medical Licensure, Ellen O'Neal, that same day. Ms. O'Neal replied:

Dr. Craig (KF: Executive Director) at Med Board is aware of this bill – he speculates that Teledoc (KF: A private telemedicine company) is responsible and that it will not get out of committee. Even if it does, though, it doesn’t really take away Health’s directive to also write regulations on Telemedicine, so Health would still be required to do our own regs.

Let’s just proceed with our regs and keep an eye on this bill. Can we get Natalie to watch it for us?

Ms. Kanosky sent an email to Mississippi State Health Department Executive Director Dr. Mary Currier on February 22, 2016 that stated:

Dr. Currier, at the last minute I have changed plans and will not be traveling to DC this week. However, Dr. Edney and Dr. Hill will both be there. I’m staying here to stage a news conference on Thursday to rally physicians against a bad telemedicine bill. I hate to miss the awards dinner but I know you will do us all proud. Thanks again for all you do. CK

Dr. Currier replied later that day:

No problem – I wondered about whether you would still be going when all the plans were made on the call last week regarding the telemedicine bill and rallying the troops. It is certainly for a good cause.

Sorry we were late on the call last week – I must have dialed in incorrectly – it took me a couple tries to get in (operator error).

I will try not to embarrass the state….

Ms. Kanosky sent another email on March 14 with this headline and message:

Telemedicine Strategy Meeting 5 pm Wednesday, March 16

On behalf of MSMA, I will host a strategy session regarding HB 1178, telemedicine, at 5 pm on Wednesday, March 16, 2016 at the MSMA headquarters in Ridgeland. The purpose of this meeting is to solidify medicine’s position on telemedicine legislation and to coordinate medicine’s strategy to get that position passed into law. All interested parties are urged to attend. Please let us know whether to expect you: Just click on “yes” or “no” right above the date stamp at the top of this email.

Daniel Edney, MD
MSMA President 2016

R. Dave Roberts, III, Director of Governmental Affairs for MSMA, asked Dr. Currier to sign a letter opposing a telemedicine bill on March 14 as well:

Good morning Dr. Currier. Please see attached draft. We are awaiting a couple of additional groups that are looking to sign on. Thanks!

She replied that she had to check with her boss. Dr. Luke Lampton, Chairman of the Mississippi State Health Department Board, authorized her to sign the letter in an email later that day:

I am ok with you signing the letter, and in fact, if MSMA needs us, I encourage you to sign. Looks like UMMC and Academy of Peds are signing on too.

Not the best written letter in my opinion, but I think the sentiment is something worth supporting. There is some political risk more for us than MSMA, but if state-owned UMMC is willing to stand up for this, I feel better about us, specifically you as head of a state agency, doing it. It also seems more a quality issue, standing up for more than "audio only." Thus, I think we wont be criticized too much for making a stand about quality of care.

Also, MSMA has been a great supporter of us, and I see no significant negative impact politically by standing with them on this issue.

Thus, sign, and sorry for my delay!

The MSMA also announced it's opposition to the telemedicine bill in an official statement.* HB #1178 passed the House but died in committee in the Senate.

It appears that the Mississippi State Medical Association might have wanted to check its own emails and letters before it tried to attack the Kingfish. The emails show collaboration between the Mississippi State Medical Association, Mississippi State Department of Health, UMMC, and Mississippi Board of Medical Licensure last year in stopping any bills that threatened their control of telemedicine in Mississippi. What is "inappropriate" is Mr. Reeves' email to yours truly.

*Text of statement in blast email:

MSMA Opposed Legislation

*TELEMEDICINE UPDATE: Last night members of the MSMA Board of Trustees and invited guests met to discuss the status of HB 1178. After much debate, the group decided that no bill is better than a bad bill, and the best course of action is to urge Senate leadership, including the Lieutenant Governor and committee chairs, to kill this bill and work towards a comprehensive telehealth bill next year. MSMA staff is communicating that message to the Senate today.

HB 1178: Redefine the Practice of Telemedicine: Attempts to update the current statutory definition of telemedicine and allows audio-only physician visits. This was introduced in response to a number of out-of-state private companies that are offering physician access direct to consumers. This bill passed the house and has been assigned to the Senate Committee on Public Health.

You gotta love the arrogance of the State Medical Association. It reflects the arrogance of the doctors that it represents. They are a powerful group and have stormed over many individuals and organizations without regard for what is best for Mississippians. Instead, their focus is solely on what is best for doctors' wallets. I'm quite happy to see them take a jab and left hook from KF.

I am concerned that a private association has that much influence over the Department of Health. The Department complains about lack of funding and their inability to provide services. We have the worst Department of Health in the country and they are worried about being aligned with the Medical Association? They complain about not being able to provide services because of budget cuts and they want to work against a deliver model that would provide poor, underserved patients from receiving services?

So, you are telling me the Department of Health takes direction on what legislation to support from the MS State Medical Association? Is the Department of Health a state or private Department? Our tax dollars are going to fund the agenda of the MS State Medical Association? No wonder the nurses have such an issue providing care to Mississippi's most vulnerable population. What a disgrace.

I don't see the problem with MSMA, a great association representing a honored and esteemed profession, working with the Department of Health to kill bad legislation is. I for one am happy that we have a strong medical association working with the Department of Health and the Board of Medical Licensure for that matter. Stay out of our practice.

The problem with a for-profit business influencing a tax payer funded Department is that emails between the two are PUBLIC RECORD. Apparently Mr. Reeves did not learn that in law school. Instead of snipping at Kingfish, shouldn't he have advised his boss to not put anything in an email she did not want the public to see? Especially an email that directly shows a private company influencing decision making of a state run agency to restrict trade? Law 101, Mr. Reeves. Think next time before you send an email with no substance. In fact, don't send the email. Always make a phone call.

I am ok with you signing the letter, and in fact, if MSMA needs us, I encourage you to sign. Looks like UMMC and Academy of Peds are signing on too.

Not the best written letter in my opinion, but I think the sentiment is something worth supporting. There is some political risk more for us than MSMA, but if state-owned UMMC is willing to stand up for this, I feel better about us, specifically you as head of a state agency, doing it. It also seems more a quality issue, standing up for more than "audio only." Thus, I think we wont be criticized too much for making a stand about quality of care.

Also, MSMA has been a great supporter of us, and I see no significant negative impact politically by standing with them on this issue.

Thus, sign, and sorry for my delay!

This is very bothersome: "but if state-owned UMMC is willing to stand up for this, I feel better about us, specifically you as head of a state agency, doing it."

Where are the ethics in our state? How can one person, Charmain Kanosky, have so much control over state entities. Does MSMA and UMMC have some type of sweetheart deal, a kickback? What is it?

All you have to do is look at the composition of the Board of Health. You will see that by law, the majority of members must be doctors (and guess what association they all belong to?). And guess who is chairman? And guess who is a card carrying die hard loyal member of MSMA? And guess what department has gone down, down, down during his chairmanship? The Department of Health is nothing more than a division of MSMA designed to make sure that public health efforts don't infringe on the proprietary interests of the doctors in MS. After all, every doctor deserves at least two vacation homes.

Remove the profit incentive from healthcare. Healthcare should be about preventing sickness and healing those that are ill - not making a shit load of money. If you become a doctor solely for the purpose of becoming wealthy you are ethically unsound like Colonel Kurtz and will burn in hell provided there is a hell and the Christians are right....

As a physician, I would like to state that the Mississippi Medical Association does NOT speak for me.

I am an employed physician at UMMC and let me tell you, this post has gone viral at the Med Center today. There are many, many physicians who feel the same way I do about our current representation by the administration at the Medical Association. I would say the majority I interact with would like to see change.

to answer the questions about kickbacks between MSMA and UMMC, I would say it is not necessarily a kickback but my membership in MSMA is paid for by UMMC, as is all physicians employed at UMMC. If I could find a way to not be a member under this current administration, I would.

I am confident a public records search would show how UMMC pays for all of the membership dues to MSMA of each and every physician at UMMC. Membership dues are not cheap--therefore your sweetheart deal is MSMA receiving a huge chunk of UMMC's money every year for a large amount of membership dues.

However, the majority of physicians here would rather UMMC's money be used for a good cause, not to pay the large salaries of the MSMA administration.

I'd like to have more telemedicine options in the state, but telephone only sounds worrisome to me. I get that some people live in areas where they don't have good enough reception to Facetime (sorry, I know that you love BB, KF), but choosing to ignore public health risks because of delivery hurdles seems foolish. We need more access to quality care, not just "care".

This has nothing to do with protecting only 'one system', and that one system being UMMC. That is simply outrageous and false. It has very much to do with understanding the clinical implications of phone-only medicine, and much more to do with implications of language in Bill 1178 bill itself.

You, nor anyone else have yet to directly address among others, the three huge glaring issues with the language in last year's legislation:

1) mandated patient-driven choice of technology even if this technology may not be appropriate;

The bill last year mandated that PATIENTS not qualified health professionals drive the choice of telemedicine technology. That is nuts both from a quality of care perspective and from an innovation perspective.

-I want to start a taxi cab company, but I now have to have an SUV, a convertible, and a truck to start it.-It's much more expensive to start this service now. -A patient wants me to take them to the cold frozen mountains. -I have a taxi vehicle that is 4 wheel drive and warm, but the patient insists it has to be in a top-down convertible. -I now have to figure out how make my two wheel drive convertible go up the frozen mountain safely when it did not even make sense to be used in this context to begin with.

2) mandated equal cost regardless of communication method even if some methods are significantly cheaper;

-This would be similar to a patient requesting which diagnostic test or procedure they want done, and then for that diagnostic test or procedure to cost the same regardless of type.

With this bill, a patient could ‘choose’ not have Store and Forward consults, and request a “live video conference.” This would completely ruin the established innovation in escalation through telemedicine. Not only that, but the Bill would make the much cheaper Store and Forward consult would now have to be offered at a higher price than necessary since the Bill mandates that the cost must be the same regardless of communication method.

How’s that for stifling innovation. And this example is specific to only this specialty.

3) dangerous codification of physician-patient relationship that makes it easily defined for a singular visit and then easily terminated after one visit;

“the physician agreed to treat or diagnose only a specific condition or agreed to diagnose or treat only at a specific time or place and that condition diagnosis or treatment has ended”

*Based on this language, I can over the phone only consent to treat you for only one specific visit and treat your headache based only over what symptoms you describe to me in that specific visit. *If you think the issue resolved and later something much more serious happens, well our physician-patient relationship was established and terminated only in the very specific context described above. I am not liable.

One year later, you still refuse to discuss the specifics of last year's bill and their very negative downstream consequences. Instead you frame it as some conspiracy for click bait.

Having worked at the Association in the past, I can attest Charmian is a professional bully. First, Mr. Reeves has been heard bragging that Kingfish has always "removed" or "changed" a stance on issues after Mr. Reeves request he do so. And Mr. Reeves only does what Charmian tell him.

Secondly, how can she be objective? While her compensation is considerable, her husband (a physician) is effected by every positon the MSMA advocates. She has a shockingly expensive life-style that she in no way wants altered. She has a vested interest in protecting the financial success of certain physicians - not all doctors and certainly not the public.

Finally, I commend Kingfish on obtaining the emails. There are almost daily private calls, emails, and meetings that are planned to only keep certain board members informed.

If at any point an employee or board member questions the ethical nature or fiduciary duty of an Association action, that employee or member is fired and/or "accidently" omitted from future phone calls.Please keep up the good work!

I always laugh at the people that make the "quality care" argument. Telemedicine has never been about people with serious illnesses, but rather for those that clog up the Ambulances and Emergency rooms for conditions that could be very simply treated and often don't require a prescription. Call 911 with a cough and you get an ambulance and most likely a firetruck due to "difficulty breathing". Pretty expensive for the ole taxpayer when you round up the costs of all that response, to a condition that could probably be handled with OTC cough syrup.

Lest we forget this painkiller epidemic we now face didn't come from Mexico, but rather from the prescription pads of the very same people who know whats "best" for Mississippi's healthcare future.

Well, Wow, the post just discusses what one side was promoting and what the other side opposed. It didn't advocate one form of telemedicine over the other. There are indeed various forms of telemedicine although be honest, there is one group that would like to see only one model used in Mississippi and that is it.

UMC has expensive new office space off Highland Colony to pay for. Telemedicine is the golden ticket and if a large chunk of dues are paid for by the state's teaching hospital, what's wrong with a lil quid quo pro?

Well, this is embarrassing for the attorney in question. Just because you have a law degree doesn't mean you can email threats with no legal ground. Wow. He is almost as pompous as the physicians he represents.

We are lucky folks like "12:57pm" don't make the decisions. Facts get in the way of emotions.

" always laugh at the people that make the "quality care" argument. Telemedicine has never been about people with serious illnesses, but rather for those that clog up the Ambulances and Emergency rooms for conditions that could be very simply treated and often don't require a prescription. Call 911 with a cough and you get an ambulance and most likely a firetruck due to "difficulty breathing". Pretty expensive for the ole taxpayer when you round up the costs of all that response, to a condition that could probably be handled with OTC cough syrup."

How does anything in this article show this Charmaine person has "worked actively behind the scenes .... to keep telemedicine companies from operating in Mississippi that would compete with UMMC"? She said she was fighting a "bad telemedicine bill." I assume that's one of the things MSMA does is fight what it thinks is bad medicine bills.

@5:31- then why did her legal counsel, or lack of legal counsel send the email to KF?

I was taught to stand up for what you fight for or against. Why hide it?

That's like someone who is an avid smoker working to ban smoking statewide.

I’ve seen your comment posted to the “Med Board Cans Executive Director” article at 7:58am today and I’m objecting to its posting. You made an unsubstantiated assertion of fact about actions by Charmain Kanosky and are publishing an allegation that is unfounded and inappropriate. Please remove that comment from the article. Thank you for your attention to this, (Emphasis added by KF)

This Reeves guy taught a CLE I took. I thought he was amateur hour during the CLE. This just goes to prove I was correct. I learn more legal expertise from reading my kid's civics books as I do listening to this dude talk at a CLE. The MS Bar should reconsider allowing hum to continue providing CLEs seeing he doesn't even know the first thing about the law.

@5:56, this is 5:31. What? Reeves just took issue with the allegation that Charmain was working "behind the scenes" or trying to stifle competition with UMMC. How can going to the Capitol in public to fight a bill be considered behind the scenes? The MSMA is a lobbying association. That's what they do is OPENLY challenge legislation they don't think is good. And asking other respected people in the state (Currier, Lampton) to back them up is also part of that process. Yes, she on behalf of the MSMA was actively fighting legislation that would allow bad medicine (according to them) but it doesn't appear it had anything to do with keeping down competition with UMMC.

1:09 pm I read 10:50 pm's email. It was very informative. I am interested in the subject because I effectively used face to face telemedicine after a rare surgical complication that was not described in the " handouts" I took home.The face to face allowed the doctor to see what I was seeing and experiencing. It saved my life. By the time my surgeon's nurse called, I had already been treated at ER in time.Indeed, I wish doctors or their staff would have a cell phone or email function just to be able to " see" or " hear" symptoms. The " old way" of doing things doesn't work as well as it did as medicine has become more focused on maximizing the number of patients a doctor sees. The burden of deciding to go to ER falls on the patient as the computer answering messages at doctor's offices on weekends indicate.Few people would go to an ER by choice if they've ever been once. And, a person usually feels too bad to want to leave home and go anywhere when they need ER.Medicine should be about the best delivery of health care possible at the least cost possible. If it continues to be about profit and politics, we are insuring a continuing downward spiral in every health care category when compared to other nations.

As a doctor practicing in Miss for over 25 years, I can attest to the tremendous work that MSMA has done to foster good medical practice in our state. Charmain works hard to facilitate that effort. It's a rough job dealing with so many factions. This telemedicine issue is a great example. It is unreasonable to omit a video requirement for telemedicine. That's what Charmain (MSMA), Currier, Med licensure board, etc. were trying to accomplish. Contrary to some opinions posted here, it's not to protect income or UMC. It's to protect patients

FInally, a comment on the positive work accomplished by the MSMA. Thank you, 4:25p.

KF-there is lots of speculation over who is motivating your interest in this group. I know it's hard to believe, but most physicians are first concerned about their patients and protecting them from unsafe practices.

Who is the Hottest Reporter in Jackson?

Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything). Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up. In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.Note: Security provided by INS.

Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!